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may result in forfeiture of contractual payments. <br />sa+ <br />I hereby affirm under the penalties of petj ury that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this na day of Aj -, 2013 <br />f�inwm &AUC TG SC Ry <br />Contractor/Bidder (Firm <br />Signature of C itractor/Bidder or Its Agent <br />P*xyCAKUN 4,rP. <br />Printed Name and Title <br />n� <br />Subscribed and sworn to before me this -�L day of U Cl . , 20 <br />My Commission Expires A(�- <br />Not y Public <br />County of Residence r71KtlAKT <br />JANEEMTOWNER i <br />NOTARY PUBLIC <br />SEAL <br />ELWART COUNTY, STATE OF INDIANA <br />COMMISSION EXPIRES FEBRUARY 12.202a <br />COMMISSION NO.710399 <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />